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SILibinin in NSCLC and BC Patients With Single Brain METastasis (SILMET) (SILMET)

Primary Purpose

Brain Metastases, Adult, Non Small Cell Lung Cancer, Breast Cancer

Status
Recruiting
Phase
Not Applicable
Locations
Italy
Study Type
Interventional
Intervention
Silibinin
Placebo
Sponsored by
Alessia Pellerino
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Brain Metastases, Adult focused on measuring Silibinin, Single Brain Metastasis, Non-small-cell Lung Cancer, Breast Cancer

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Histologically confirmed BM from NSCLC or BC by local pathology Single BM (maximum diameter of 3 cm) on MRI before surgery Complete surgical resection (MRI-verified within 14 days prior randomization) pSTAT3 score in reactive astrocytes of peritumoral tissue confirmed by local or central assessment patient must have recovered from the effects of surgery, including post-operative infection, suture/stample removal from brain surgery and wound healing before randomization ≥ 18 - 70 years of age Karnofsky performance status ≥ 70 at assessment ≤ 14 days prior to randomization patient has adequate bone marrow, renal, and hepatic function ≤ 21 days prior to randomization as follows: absolute neutrophil count (ANC) ≥ 1500/mm3 platelets ≥ 100000/ mm3 Hemoglobin ≥ 9.0 g/dl (Note: the use of transfusion or other intervention to achieve hemoglobin ≥ 9.0 g/dl is acceptable) renal function: calculated creatinine clearance ≥ 30 ml/min by the Cockcroft-Gault formula hepatic function: total bilirubin ≤ 1.5 times upper limit of normal (ULN), aspartate aminotransferase (AST), and alanine transferase (ALT) ≤ 3 times ULN. Subjects with Gilbert's syndrome documented in medical history may be enrolled if total bilirubin is < 3 times ULN Electrocardiogram (ECG) without evidence of acute cardiac ischemia ≤ 21 days prior to randomization Female subject of childbearing potential (i.e. those who are not postmenopausal for at least 1 year or surgically sterile by bilateral salpingectomy, bilateral oophorectomy or hysterectomy) should practice at least one accepted method of birth control listed below during study entry, for the entire duration of the study and for at least 6 months after treatment with silibinin has ended. Male subjects should practice at least one accepted method of birth control listed below during study entry, for the entire duration of the study and for at least 6 months after treatment with silibinin has ended. If using a condom, practice at least one other method of birth control listed below during the study for at least 6 months after silibinin treatment: Combined (estrogen and progesterone contained) hormonal contraception (oral, intravaginal, transdermal) associated with the inhibition of ovulation Progesterone-only hormonal contraception (oral, intravaginal, transdermal) associated with the inhibition of ovulation Bilateral tubal occlusion/ligation True abstinence: refraining from heterosexual intercourse when this is in line with the preferred and usual lifestyle of the subject A vasectomized male subject or a vasectomized partner of a female subject Intrauterine device, IUD (females) Double-barrier method (condoms, contraceptive sponge, diaphragm or vaginal ring with spermicidal jellies or cream) unless not deemed acceptable as highly effective contraception by local regulations Women of child-bearing potential must have a negative pregnancy test (urine o serum) within 7 days prior the randomization Must voluntarily sign and date informed consent form, for both tumor tissue biomarker testing and study participation, approved by an Independent Ethic Committee (IEC)/Institutional Review Board (IRB), prior to the initiation of any screening or study-specific procedures Exclusion Criteria: Absence of expression of STAT3 on the reactive astrocytes of brain metastases Incomplete surgical resection and/or diameters > 3 centimeters of brain metastasis before surgery Brain metastases that previously received any type of radiation therapy Progressive systemic disease requiring a change of the antineoplastic therapy Prior invasive malignancy (except for non-melanomatous skin cancer, oral cavity, or cervix) unless disease free for ≥ 2 years Prior, concomitant, or planned treatment with experimental agents Patients has had major immunologic reaction Patient has had a history of hypersensitivity to silibinin or excipient Patient is unsuitable to receive steroids Patient is a lactating or pregnant female Severe, active co-morbidity, defined as follows: Severe hepatic impairment (Child-Pugh C or higher [score of 10 or higher]); subject with mild or moderate hepatic impairment (Child-Pugh score of 5-9) may be eligible for treatment Unstable angina and/or congestive heart failure within the last 6 months Transmural myocardial infarction within the last 6 months Evidence of recent myocardial infarction or ischemia by the findings of S-T elevations ≥ 2 mm using the analysis of an EKG performed within 21 days prior to enrollment New York Heart Association grade2 or greater congestive heart failure requiring hospitalization within 12 months prior to enrollment History of stroke, cerebral vascular accident or transient ischemic attack within 6 months Serious and inadequately controlled cardiac arrhythmia Acute bacterial or fungal infection requiring intravenous antibiotics at the time of enrollment Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy at the time of enrollment Subject with clinically defined Acquired Immune-Deficiency Syndrome (AIDS)-defining illness. This is necessary to ensure subjects are likely to be able to receive silibinin plus standard of care according to the systemic disease Active connective tissue disorders, such as lupus or scleroderma, that in the opinion of the Investigator may put the subject at high risk of toxicity Any other major medical illnesses or psychiatric impairments that in the Investigator's opinion will prevent administrations or completion of protocol therapy Patient treated on any other therapeutic clinical protocols within 30 days prior to study entry or during participation in the study except intra-operative therapy to guide resection or experimental imaging without therapeutic intent Inability to undergo contrast-enhanced MRI scans

Sites / Locations

  • Neurosurgery Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina
  • Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University
  • Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute
  • Precision Medicine in Breast Cancer Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
  • Azienda Ospedaliera Città della Salute e della Scienza di TorinoRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Silibinin

Placebo

Arm Description

Silibinin (STAT3 inhibitor) 1 g/day taken orally every day

Placebo 1 g/day taken orally every day

Outcomes

Primary Outcome Measures

intracranial local recurrence
to investigate whether silibinin delay the intracranial local recurrence in comparison to placebo

Secondary Outcome Measures

intracranial distant recurrence
to investigate whether silibinin delay or avoid the intracranial distant recurrence in comparison to placebo
Intracranial progression-free survival
intracranial local plus distant recurrence
Overall progression-free survival
intracranial plus systemic PFS
Overall survival
to investigate whether silibinin improve the overall survival in comparison to placebo
Assessment of the quality of life of brain metastasis patients
EORTC QLQ-C30 and EORTC QLQ-BN20
to determine incidence of adverse events

Full Information

First Posted
January 4, 2023
Last Updated
January 9, 2023
Sponsor
Alessia Pellerino
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1. Study Identification

Unique Protocol Identification Number
NCT05689619
Brief Title
SILibinin in NSCLC and BC Patients With Single Brain METastasis (SILMET)
Acronym
SILMET
Official Title
A Phase 2 Randomized, Multicenter Trial on Silibinin To Prevent Intracranial Recurrence After Gross-Total Resection of Single Brain Metastasis From Non-Small Cell Lung Cancer or Breast Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Recruiting
Study Start Date
January 2, 2023 (Actual)
Primary Completion Date
January 1, 2025 (Anticipated)
Study Completion Date
January 1, 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Alessia Pellerino

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study aims to evaluate the efficacy of silibinin in preventing recurrence in the brain after complete resection of a brain metastasis (BM) from non-small-cell lung cancer (NSCLC) or breast cancer (BC).
Detailed Description
This is the first placebo-controlled study evaluating the efficacy of silibinin as STAT3 inhibitor in preventing recurrence in the brain after gross-total resection of a brain metastasis (BM) from non-small-cell lung cancer (NSCLC) or breast cancer (BC). Participants will be randomized 1:1 to silibinin 1 g/day taken orally in comparison with oral placebo 1 g/day. A contrast-enhanced brain MRI will be performed every 8 weeks to evaluate intracranial local and distance recurrence

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Brain Metastases, Adult, Non Small Cell Lung Cancer, Breast Cancer
Keywords
Silibinin, Single Brain Metastasis, Non-small-cell Lung Cancer, Breast Cancer

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Randomized (1:1) phase 2 trial
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
70 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Silibinin
Arm Type
Experimental
Arm Description
Silibinin (STAT3 inhibitor) 1 g/day taken orally every day
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo 1 g/day taken orally every day
Intervention Type
Dietary Supplement
Intervention Name(s)
Silibinin
Other Intervention Name(s)
Sillbrain
Intervention Description
Silibinin 1 g/day taken orally plus standard systemic therapy for NSCLC or BC
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Placebo 1 g/day taken orally plus standard systemic therapy for NSCLC or BC
Primary Outcome Measure Information:
Title
intracranial local recurrence
Description
to investigate whether silibinin delay the intracranial local recurrence in comparison to placebo
Time Frame
up to 12-24 months
Secondary Outcome Measure Information:
Title
intracranial distant recurrence
Description
to investigate whether silibinin delay or avoid the intracranial distant recurrence in comparison to placebo
Time Frame
up to 12-24 months
Title
Intracranial progression-free survival
Description
intracranial local plus distant recurrence
Time Frame
up to 12-24 months
Title
Overall progression-free survival
Description
intracranial plus systemic PFS
Time Frame
up to 12-24 months
Title
Overall survival
Description
to investigate whether silibinin improve the overall survival in comparison to placebo
Time Frame
up to 24 months
Title
Assessment of the quality of life of brain metastasis patients
Description
EORTC QLQ-C30 and EORTC QLQ-BN20
Time Frame
8 weeks, 16 weeks, 24 weeks, 32 weeks, 40 weeks, 48 weeks, 56 weeks, thereafter every 24 weeks
Title
to determine incidence of adverse events
Time Frame
up to 12-24 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically confirmed BM from NSCLC or BC by local pathology Single BM (maximum diameter of 3 cm) on MRI before surgery Complete surgical resection (MRI-verified within 14 days prior randomization) pSTAT3 score in reactive astrocytes of peritumoral tissue confirmed by local or central assessment patient must have recovered from the effects of surgery, including post-operative infection, suture/stample removal from brain surgery and wound healing before randomization ≥ 18 - 70 years of age Karnofsky performance status ≥ 70 at assessment ≤ 14 days prior to randomization patient has adequate bone marrow, renal, and hepatic function ≤ 21 days prior to randomization as follows: absolute neutrophil count (ANC) ≥ 1500/mm3 platelets ≥ 100000/ mm3 Hemoglobin ≥ 9.0 g/dl (Note: the use of transfusion or other intervention to achieve hemoglobin ≥ 9.0 g/dl is acceptable) renal function: calculated creatinine clearance ≥ 30 ml/min by the Cockcroft-Gault formula hepatic function: total bilirubin ≤ 1.5 times upper limit of normal (ULN), aspartate aminotransferase (AST), and alanine transferase (ALT) ≤ 3 times ULN. Subjects with Gilbert's syndrome documented in medical history may be enrolled if total bilirubin is < 3 times ULN Electrocardiogram (ECG) without evidence of acute cardiac ischemia ≤ 21 days prior to randomization Female subject of childbearing potential (i.e. those who are not postmenopausal for at least 1 year or surgically sterile by bilateral salpingectomy, bilateral oophorectomy or hysterectomy) should practice at least one accepted method of birth control listed below during study entry, for the entire duration of the study and for at least 6 months after treatment with silibinin has ended. Male subjects should practice at least one accepted method of birth control listed below during study entry, for the entire duration of the study and for at least 6 months after treatment with silibinin has ended. If using a condom, practice at least one other method of birth control listed below during the study for at least 6 months after silibinin treatment: Combined (estrogen and progesterone contained) hormonal contraception (oral, intravaginal, transdermal) associated with the inhibition of ovulation Progesterone-only hormonal contraception (oral, intravaginal, transdermal) associated with the inhibition of ovulation Bilateral tubal occlusion/ligation True abstinence: refraining from heterosexual intercourse when this is in line with the preferred and usual lifestyle of the subject A vasectomized male subject or a vasectomized partner of a female subject Intrauterine device, IUD (females) Double-barrier method (condoms, contraceptive sponge, diaphragm or vaginal ring with spermicidal jellies or cream) unless not deemed acceptable as highly effective contraception by local regulations Women of child-bearing potential must have a negative pregnancy test (urine o serum) within 7 days prior the randomization Must voluntarily sign and date informed consent form, for both tumor tissue biomarker testing and study participation, approved by an Independent Ethic Committee (IEC)/Institutional Review Board (IRB), prior to the initiation of any screening or study-specific procedures Exclusion Criteria: Absence of expression of STAT3 on the reactive astrocytes of brain metastases Incomplete surgical resection and/or diameters > 3 centimeters of brain metastasis before surgery Brain metastases that previously received any type of radiation therapy Progressive systemic disease requiring a change of the antineoplastic therapy Prior invasive malignancy (except for non-melanomatous skin cancer, oral cavity, or cervix) unless disease free for ≥ 2 years Prior, concomitant, or planned treatment with experimental agents Patients has had major immunologic reaction Patient has had a history of hypersensitivity to silibinin or excipient Patient is unsuitable to receive steroids Patient is a lactating or pregnant female Severe, active co-morbidity, defined as follows: Severe hepatic impairment (Child-Pugh C or higher [score of 10 or higher]); subject with mild or moderate hepatic impairment (Child-Pugh score of 5-9) may be eligible for treatment Unstable angina and/or congestive heart failure within the last 6 months Transmural myocardial infarction within the last 6 months Evidence of recent myocardial infarction or ischemia by the findings of S-T elevations ≥ 2 mm using the analysis of an EKG performed within 21 days prior to enrollment New York Heart Association grade2 or greater congestive heart failure requiring hospitalization within 12 months prior to enrollment History of stroke, cerebral vascular accident or transient ischemic attack within 6 months Serious and inadequately controlled cardiac arrhythmia Acute bacterial or fungal infection requiring intravenous antibiotics at the time of enrollment Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy at the time of enrollment Subject with clinically defined Acquired Immune-Deficiency Syndrome (AIDS)-defining illness. This is necessary to ensure subjects are likely to be able to receive silibinin plus standard of care according to the systemic disease Active connective tissue disorders, such as lupus or scleroderma, that in the opinion of the Investigator may put the subject at high risk of toxicity Any other major medical illnesses or psychiatric impairments that in the Investigator's opinion will prevent administrations or completion of protocol therapy Patient treated on any other therapeutic clinical protocols within 30 days prior to study entry or during participation in the study except intra-operative therapy to guide resection or experimental imaging without therapeutic intent Inability to undergo contrast-enhanced MRI scans
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Pierangela Botta
Phone
+390116334904
Email
botta.neuro.oncologia@gmail.com
First Name & Middle Initial & Last Name or Official Title & Degree
Alessia Pellerino, M.D., Ph.D.
Phone
+390116334904
Email
alessia.pellerino85@gmail.com
Facility Information:
Facility Name
Neurosurgery Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina
City
Messina
Country
Italy
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Filippo Flavio Angileri
First Name & Middle Initial & Last Name & Degree
Maria Caffo
Facility Name
Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University
City
Rome
Country
Italy
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Alessandro Olivi
Facility Name
Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute
City
Rome
Country
Italy
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Andrea Pace
Facility Name
Precision Medicine in Breast Cancer Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
City
Rome
Country
Italy
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Alessandra Fabi
Facility Name
Azienda Ospedaliera Città della Salute e della Scienza di Torino
City
Turin
ZIP/Postal Code
10126
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Alessia Pellerino, M.D., Ph.D
Phone
+390116334904
Email
alessia.pellerino85@gmail.com
First Name & Middle Initial & Last Name & Degree
Pierangela Botta
Phone
+390116334904
Email
botta.neuro.oncologia@gmail.com

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Principal Investigators will provide access to related study documents (e.g. protocol, statistical analysis plan, clinical study report) upon request from qualified researchers, and subjects with certain criteria, conditions, and exception that will be discussed with PI
Citations:
PubMed Identifier
29892069
Citation
Priego N, Zhu L, Monteiro C, Mulders M, Wasilewski D, Bindeman W, Doglio L, Martinez L, Martinez-Saez E, Ramon Y Cajal S, Megias D, Hernandez-Encinas E, Blanco-Aparicio C, Martinez L, Zarzuela E, Munoz J, Fustero-Torre C, Pineiro-Yanez E, Hernandez-Lain A, Bertero L, Poli V, Sanchez-Martinez M, Menendez JA, Soffietti R, Bosch-Barrera J, Valiente M. STAT3 labels a subpopulation of reactive astrocytes required for brain metastasis. Nat Med. 2018 Jul;24(7):1024-1035. doi: 10.1038/s41591-018-0044-4. Epub 2018 Jun 11. Erratum In: Nat Med. 2018 Jun 19;:
Results Reference
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SILibinin in NSCLC and BC Patients With Single Brain METastasis (SILMET)

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